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The effect of single-dose intravenous tranexamic acid in simultaneous bilateral total hip arthroplasty: a
Fernando Diaz Dilernia1, Allan Sekeitto2, Edward Vasarhelyi2
1Adult Hip and Knee Reconstructive Surgery, London Health Sciences Centre; Department of Surgery, Division of Orthopedic Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ont. fernando.diazdilernia@kingstonhsc.ca.
Background:
Simultaneous bilateral total hip arthroplasty (SBTHA) has been associated with high blood loss and transfusion risk. We sought to analyze the effectiveness of a single intravenous dose of tranexamic acid (TXA) on blood loss and transfusion rates in SBTHA.
Methods:
We retrospectively reviewed data from patients who underwent SBTHA with a single dose of TXA (20 mg/kg) before incision. We analyzed hematological parameters and transfusion rates. We performed a multivariate logistic regression analysis to identify independent risk factors for blood transfusion.
Results:
We included 92 patients with a median age of 60 (interquartile range [IQR] 52 to 68) years. Of these, 48 (52.2%) were male. The median follow-up time was 4.6 (IQR 3.2 to 7.0) years. Six patients had transfusions, for a transfusion rate of 6.5%. The median hemoglobin levels before surgery, on postoperative day 1, and on the day of discharge were 144 (IQR 135 to 154) g/L, 107 (IQR 93 to 118) g/L, and 101.5 (IQR 90 to 111) g/L, respectively. Longer surgical time (adjusted odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01 to 1.07) and lower preoperative platelet count (adjusted OR 1.01, 95% CI 1.00 to 1.03) were significant risk factors for transfusion. Male sex (adjusted OR 0.04, 95% CI 0.004 to 0.40) and younger age (adjusted OR 0.92, 95% CI 0.86 to 0.99) were protective factors.
Conclusion:
We found a low transfusion rate (6.5%) after SBTHA among patients administered a single dose of 20 mg/kg of TXA, with young patients and male patients at lower risk of requiring transfusions. Our results suggest that performing SBTHA with current blood management protocols is effective in patients with bilateral hip disease.
